多模态影像学方法在多发性骨髓瘤诊断及疗效评估中的研究进展

Research Progress of Multimodal Imaging Methods in the Diagnosis and Efficacy Evaluation of Multiple Myeloma

摘要: 多发性骨髓瘤是血液系统第二常见的恶性肿瘤，通过影像学检查明确骨病变，鉴定骨髓浸润及骨质破坏显得尤为重要。在多发性骨髓瘤的影像诊断及评估中，全身低剂量CT (Whole body Low dose Computed Tomography, WBLDCT)、磁共振成像(Magnetic resonance imaging, MRI)、核医学技术(PET/CT)及双能CT (Dual-Energy Computed Tomography, DECT)等技术各有优势。WBLDCT对病人辐射剂量小，可清晰显示骨质结构。多发性骨髓瘤是一个动态进展的过程，MRI凭借其对骨髓微环境变化的高度敏感性，早期即可发现骨髓浸润和软组织肿块。近年来，¹⁸F-FDG PET/CT因其能够在分子代谢水平上反映肿瘤活性，被国际骨髓瘤工作组推荐为评估治疗反应的首选技术。随着DECT在临床的逐步普及，其衍生的虚拟去钙技术(VNCa)可有效去除骨钙干扰，清晰显示骨髓内的病理改变，实现对骨髓浸润程度的可视化与定量分析。联合应用多种影像学方法形成的多模态评估体系，不仅有助于提升多发性骨髓瘤的早期诊断率和分期准确性，更为动态监测疾病演变、优化治疗策略及改善患者预后提供了强有力的支撑。在本篇综述中，多方面地对骨髓瘤影像学特征进行综述，探讨多发性骨髓瘤的影像学检查、诊断及疗效监测。

Abstract: Multiple myeloma (MM) is the second most common malignant tumor of the hematological system. It is particularly important to clarify bone lesions, identify bone marrow infiltration and bone destruction through imaging examinations. In the imaging diagnosis and evaluation of MM, various technologies including whole-body low-dose computed tomography (WBLDCT), magnetic resonance imaging (MRI), nuclear medicine technology (PET/CT), and dual-energy computed tomography (DECT) have their own advantages. WBLDCT has a low radiation dose to patients and can clearly display bone structure. As a dynamically progressive disease, MM can be detected early for bone marrow infiltration and soft tissue masses by MRI, which is highly sensitive to changes in the bone marrow microenvironment. In recent years, 18F-FDG PET/CT has been recommended by the International Myeloma Working Group (IMWG) as the preferred technique for assessing treatment response due to its ability to reflect tumor activity at the molecular metabolic level. With the gradual popularization of DECT in clinical practice, its derived virtual non-calcium (VNCa) technology can effectively eliminate the interference of bone calcium, clearly display pathological changes in the bone marrow, and realize the visualization and quantitative analysis of the degree of bone marrow infiltration. The multimodal evaluation system formed by the combined application of multiple imaging methods not only helps to improve the early diagnosis rate and staging accuracy of MM, but also provides strong support for dynamically monitoring disease progression, optimizing treatment strategies, and improving patient prognosis. In this review, the imaging characteristics of myeloma are summarized in various aspects, and the imaging examination, diagnosis and efficacy monitoring of MM are discussed.